AADPRT – 2008 Psychiatry Update

1. AADPRT – 2008Psychiatry Update • Residency Review Committee • for • Psychiatry • Victor Reus, MD, Chairman

2. Review Committee Staff • Larry Sulton, Ph.D. Senior Executive Director • Lynne Meyer, PhD, MPH, Executive Director • Susan Masker, Associate Executive Director • Jennifer Luna, Accreditation Administrator • Sandra Benitez, Accreditation Assistant

3. Elizabeth L. Auchincloss, MD Jonathan F. Borus, MD Marshall Forstein, MD James J. Hudziak, MD David Mrazek, MD, Gail Manos, MD Jonathan E. Morris, MD Kayla Pope, MD (resident) Review Committee • D. Burton V. Reifler, MD • Cynthia Santos, MD • Kailie Shaw, MD • Aradhana A. Sood, MD • Allan Tasman, MD • Christopher Thomas, MD • Michael J. Vergare, MD

4. Review Committee Appointing Organizations American Board of Psychiatry and Neurology Larry Faulkner, MD, Ex-Officio American Medical Association Barbara Schneidman, MD, Ex-Officio American Psychiatric Association Deborah Hales, MD, Ex-Officio

5. Review Committee Appointment Process • Identify geographic and specialty needs • Review qualifications of nominees • Recommend appointment to ACGME • ACGME confirms appointments

6. Number of Accredited Programs July 1, 2007 – June 30, 2008 SpecialtyProgramsResidents Psychiatry 181 4839 Addiction 41 57 Forensic 42 75 Geriatric 60 87 Psychosomatic 36 50

7. Average Survey Cycle Length • 2006 - 2007 • General Psychiatry 4.58 • Addiction 4.43 • Forensic 4.62 • Geriatric 4.63

8. Review Committee Decisions (2007) • General Psychiatry • Status Programs • Initial Accreditation 1 • Continued Accreditation 40

9. New Program Directors • July 1, 2006 – June 30, 2007 • Programs New Directors % • 181 28 15.47

10. Program Requirements Frequently Cited • Responsibilities of Program Faculty -Devote sufficient time to the educational program -Maintain an environment of inquiry and scholarship -Participate regularly in the educational program

11. Program Requirements Frequently Cited • Institutional / Program Resources -Patient populations for each mode of education -Adequate inpatient/outpatient facilities -Office space for residents to interview patients

12. Program Requirements Frequently Cited • Supervision -Each resident must receive a minimum of two hours of direct supervision per week, at least one of which is individual

13. Program Requirement Change: clinical skills assessment • The resident must make an organized presentation of pertinent history, including the mental status examination. • In at least 3 evaluations, residents must demonstrate competence in a) establishing an appropriate doctor/patient relationship, b) psychiatric interviewing, and c) case presentation.

14. Program Requirement Change: clinical skills assessment • The program must ensure that each of the required 3 evaluations is conducted by an ABPN-certified psychiatrist. • At least two of the evaluations must be conducted by different ABPN-certified psychiatrists. • Demonstration of the competencies during the 3 required evaluations is required prior to completing the program.

15. Future Review Committee Meetings Meeting Date Request Submission Deadline April 4-5, 2008 Closed October 17-18, 2008 August 28, 2008 April 24-25, 2009 March 2, 2009

16. AADPRT 2008Psychiatry Update • Child and Adolescent Psychiatry • Sandra Sexson, MD • Past • Review Committee Chair

17. Average Survey Cycle Length • 2006 - 2007 • Child Psychiatry 4.84

18. Review Committee Decisions (2007) • Child Psychiatry • Status Programs • Initial Accreditation 6 • Louisiana State U (Shreveport) • Southern Illinois University • Ponce School of Medicine (PR) • Carilion Clinic/U VA • U of Tennessee/Memphis • UCLA Kern/Bakersfield • Continued Accreditation 25

19. New Program Directors • July 1, 2006 – June 30, 2007 • Programs New Directors % • 114 13 11.4

20. Number of Accredited Programs July 1, 2007 – June 30, 2008 SpecialtyProgramsResidents Child Psychiatry 121 796

21. Program Requirements Frequently Cited • Responsibilities of PD (19%) • Incomplete/inaccurate PIF • Failure to insure adequate clinical experiences • Patient volume • Patient diversity • Failure to obtain prior approval for resident complement changes

22. Program Requirements Frequently Cited • Inadequate scholarly activity (12%) • Primarily inadequate documentation of scholarly activity for faculty • Institutional support (12 %) • Missing affiliation agreements • Missing program letters of agreement (PLAs) • Inadequate hospital records systems

23. ACGME Requirements • Institutional Requirements (Sponsor) • Common Requirements (All Specialties) • Program Requirements (Psychiatry)

24. INSTITUTIONAL REQUIREMENTS • Institutional Requirement III.A.2.b • In selecting from among qualified applicants, it is strongly suggested that the Sponsoring Institution and all of its ACGME-accredited programs participate in an organized matching program, such as the National Resident Matching Program (NRMP), where such is available

25. Post Pediatric Portal Project • Background • AACAP submitted proposal to ACGME via Psychiatry RRC for a pilot program for combined training in general and child and adolescent psychiatry (8/25/06) • Letter to RRC to support the PILOTprogram from APA, ABPN, AADPRT, and a number of consumer organizations • Approved as an Educational Innovation Project by ACGME and Psychiatry RRC • Description and LOI and RFA on ACGME website

26. Summary of the Proposal • 3 yr program for fully trained pediatricians to achieve ABPN eligibility for certification in both general and child psychiatry • Limited number of programs (max 10) for 5 years • Both psychiatry and CAP programs must be in same academic center and must have 4 year accreditation cycles – may be more flexible • RRC will monitor but will work with stakeholders to facilitate project, assess competency measures, etc. (AACAP, APA, AADPRT, ABPN)

27. Requirements • Also available on ACGME Website • Integration and Continuity between the programs optimal • Programs must meet all the specified requirements of both general and CAP training except for the following exceptions: • Delineated areas which can be double counted • 1 mo ped neurology • 1 mo. Ped c/l • 1 mo. Addiction • Forensic and community experiences • 20% of outpatient experience • Adult outpatient experience must include some cases that are seen for at least a year to facilitate psychotherapy training • Decreased adult inpatient requirement • Minimum 4 months but must be monitored carefully to demonstrate broad range of exposure to patients across gender, culture, and diagnostic categories

28. Project Objectives • To offer abbreviated training to fully trained pediatricians as previously described • To advance competency based education and outcomes based assessment • The Process • Psychiatry RRC will select proposals from fully accredited psychiatry and CAP programs that are in good standing with the RRC • Psychiatry RRC will monitor resident progress, through demonstrated achievement of competencies throughout training as well as performance on in-training exams and certification exams • Report to ACGME and to field the outcome to determine if such training should be supported by the Psychiatry RRC in the future

29. Scope of Project Maximum of 10 sites (Gen and CAP must apply together Limited to 2 trainees per year for each program Minimum of 5 years for study Oversight by Psychiatry RRC • Annual reports from programs addressing PIF parameters • RRC representatives to meet face to face with program directors at least 3 times, probably at AADPRT mtg. • Ongoing feedback from Psychiatry RRC annually • Input from stakeholders regarding ongoing assessment as well • Resident reflections through portfolio process

30. Evaluation • Measurement of core competencies • Comparison of performance on standardized in-training examinations • Comparison of performance on ABPN certifying examinations

31. Post Pediatrics Portal Project Update • 3 Programs Approved • Case Western Reserve University/University Hospitals of Cleveland effective July 1 2007 • Maryellen Davis, MD • Creighton University/University of Nebraska effective July 1 2008 • Jamie Snyder, MD • Children’s Hospital of Philadelphia effective July 1 2008 • Tami Benton, MD • 4 Others Submitted LOI • 1 withdrew because of lack of funding • no other completed applications • Primary obstacle -- funding

32. Post Pediatrics Portal Project • RRC wants this to work!!! -- Call or email Susan Mansker (smansker@acgme.org) or visit the ACGME website if you have questions. • RRC has extended deadlines and will take LOI or applications at any time until further notice • RRC will relax some of the requirements if all other indicators are positive. • Time length for accreditation cycle for either or both programs • Time length PD has been in program

33. New CAP RequirementsEffective July 1 2007Changes • CAP training may be initiated at any point in the psychiatry residency sequence, including the PGY-I level • Electives that are integrated into a research training sequence are encouraged but must be approved by RRC for review and approval

34. Program Director • The program director must be provided a minimum of 50% (20 hours per week) protected time to fulfill program leadership responsibilities • Adequate lengths of appointment are essential for continuity…in general the minimum term of appointment must be at least the duration of the program plus one year

35. Changes Regarding Faculty • Programs with larger patient populations, multiple institutions and larger resident complements will be expected to have the number of faculty appropriate to the program’s size and structure • The Physician Faculty will be looked at closely to be sure there is adequate supervision from physicians to foster identity development as a CAP. • More specifics about the Head of CAP

36. Program Personnel and Resources • There must be a residency coordinator who has adequate time, based on program size and complexity, to support the residency program • Library wording is changed to permit electronic vs. print format availability

37. Scholarly Activity Issues • Research Literacy for all • Research opportunities and research skills training for all residents who are interested in research • Active participation of faculty in evidence based discussions, with demonstrable research in the Division

38. The Competencies • Requirements have been organized under the various competencies • With the exception of Patient Care and Medical Knowledge, the Common Requirements will specify the competency requirements with only a few added that are specialty specific

39. Patient Care • Work with patients from each developmental group over time, “whenever possible” for a year or more. • Record to demonstrate variety, etc. available for review of site visitor • Clinical record content is defined.

40. Medical Knowledge • 70% resident attendance to didactics which includes any absences because of duty hour restrictions • No other major changes

41. Practice-based Learning and Improvement • From the Common Requirements • Focuses on the goals and objectives and attendance at conferences • Lists performance evaluation, appraising evidence, using information technology and active participation in education of patients, families and health professionals as a requirement

42. Interpersonal and Communication Skills • Common Requirements regarding effective communication, leadership roles and consultation roles • Also addresses medical record keeping

43. Professionalism • Common Requirements includes responsiveness to needs of patients and society that supercedes self interest • Ethical standards based on AMA, APA and AACAP codes of ethics • Sensitivity and responsiveness to diversity in gender, age, culture, race, religion, disabilities and sexual orientation, etc.

44. Systems-based Practice • Common Requirements • Practice delivery systems, cost-effectiveness • Advocacy (and for us) including disparities in mental health care for children and adolescents • Acknowledging medical errors and examining systems to prevent them • UR, QA, PI

45. Supervision • “While supervision by nonphysician faculty is valuable, residents must be provided sufficient supervision from CAPs to enable each resident to establish working relationships that foster identification in the role of a CAP.” • CAP continued the 2 hour individual rule, although general switched to 2 hours, one of which could be group

46. Moonlighting • Brought forward the requirements for moonlighting policies from the Common Requirements: • Can’t be required to moonlight • Need prospective written permission in resident’s file • Monitor performance for adverse effects • Internal moonlighting must be included in 80 hour rule

47. Assessment Issues • Lists some of the techniques approved by ACGME • Delineates more frequent evaluations if residents are having problems, including the need to remediate unsatisfactory performance as possible • FINAL EVALUATION – please remember the requirements – statement about absence of unethical behavior or clinical incompetence along with statement about ability to practice competently

48. Program Evaluation • Common requirements require organized review of the program with documentation and identification of any deficiencies which then must have an explicit plan of action for addressing problems • ABPN resident performance—for graduated residents eligible to sit for the exam over past 5 years, at least 50% should pass on first attempt and 70% should take

49. Program Requests • The program must obtain the prior approval of the DIO before requesting RRC approval, such as • a change in the format of the educational program • a change in resident complement for those specialties that approve resident complement • a request for experimentation or innovative project that may deviate from the program requirements (e.g., research tracks)

50. Resident Transfers • A documented procedure must be in place for evaluating the credentials, clinical training experiences, past performance, and professional integrity of residents transferring from one program to another, including from a general psychiatry to a child and adolescent psychiatry program.